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Long-term moderately elevated LDL-cholesterol and blood pressure and risk of coronary heart disease
Peter Ueda1,2,3, Pablo Gulayin1,4, Goodarz Danaei1,5
1Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America.
Insights
Long-term exposure to moderately high LDL cholesterol and blood pressure significantly increases coronary heart disease (CHD) risk. This risk is comparable to shorter periods of very high levels, highlighting the cumulative impact of sustained exposure.
Area of Science:
- Cardiovascular epidemiology
- Preventive cardiology
- Biostatistics
Background:
- The long-term impact of moderately elevated low-density lipoprotein (LDL)-cholesterol and blood pressure on coronary heart disease (CHD) risk is not well-established.
- This study investigates whether sustained moderate exposure poses a similar CHD risk as intermittent high exposure.
Purpose of the Study:
- To estimate and compare the 16-year risk of coronary heart disease (CHD) under different durations of exposure to moderately elevated LDL-cholesterol and blood pressure.
- To evaluate the cumulative effect of sustained moderate risk factor levels versus shorter periods of higher levels.
Main Methods:
- Utilized data from 2,714 adults in the Framingham Offspring Study, free of cardiovascular disease and under 70 years old at baseline.
- Employed the parametric g-formula to model 16-year CHD risk based on varying levels and durations of LDL-cholesterol and systolic blood pressure exposure.
Main Results:
- Sustained exposure to moderate LDL-cholesterol (<160 mg/dL) resulted in an estimated 16-year CHD risk of 8.9%, comparable to shorter exposures of high or very high LDL levels.
- Similar findings were observed for blood pressure, indicating that long-term moderate elevations carry a comparable CHD risk to shorter high-level exposures.
Conclusions:
- Long-term exposure to moderate levels of LDL-cholesterol and blood pressure significantly contributes to coronary heart disease risk.
- The cumulative impact of sustained moderate risk factor elevation is equivalent to shorter periods of higher risk factor levels.
Background:
Harmful effects of long-term exposure to moderately elevated low-density lipoprotein (LDL)-cholesterol and blood pressure on coronary heart disease (CHD) have not been rigorously examined. We estimated the risk of CHD under long-term exposure to moderately elevated LDL-cholesterol and blood pressure compared with the risk under shorter exposures to higher levels of the same risk factors.
Methods:
Observational study using data from 2,714 adults in Framingham Offspring Study who were free of existing cardiovascular disease and aged <70 years at baseline (1987-1991). We used the parametric g-formula to estimate 16-year CHD risk under different levels and durations of exposure to LDL-cholesterol (low: <130 mg/dL, moderate: 130 to <160 mg/dL, high 160 to <190 mg/dL, and very high: ≥190 mg/dL) and systolic blood pressure (low: <120 mmHg, prehypertension: 120 to <140 mmHg, stage 1 hypertension: 140 to <160 mmHg, and stage 2 hypertension: ≥160 mmHg).
Results:
The estimated 16-year CHD risk under exposure to low LDL was 8.2% (95% CI = 7.0-9.6). The 16-year CHD risk under exposure to moderate LDL was 8.9% (7.8-10.1) which was similar to CHD risk under 8 years of low LDL followed by 8 years of high LDL at 9.0% (7.7-10.3); and 12 years of low LDL followed by 4 years of very high LDL at 8.8% (7.6-10.1). The results for blood pressure were similar.
Conclusions:
Long-term exposure to moderate levels of LDL-cholesterol and blood pressure had a similar impact on CHD risk as shorter exposures to levels considered 'high' per clinical guidelines.
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